﻿<?xml version="1.0" encoding="utf-8"?>
<!--273 Insurance/Annuity Application Status-->
<TransactionSpecification TransactionSetIdentifierCode="273" xmlns="http://tempuri.org/X12ParserSpecification.xsd">
  <Segment SegmentId="BGN" Usage="Required" Repeat="1" />
  <Segment SegmentId="CUR" Repeat="1" />
  <Segment SegmentId="UD" Repeat="1" />
  <Loop LoopId="NM1" LoopRepeat="">
    <Name>Individual or Organizational Name</Name>
    <StartingSegment SegmentId="NM1" />
    <Segment SegmentId="N3" Repeat="3" />
    <Segment SegmentId="N4" Repeat="1" />
    <Segment SegmentId="REF" Repeat="9" />
    <Segment SegmentId="PER" Repeat="3" />
  </Loop>
  <Loop LoopId="ACT">
    <Name>Account Identification</Name>
    <StartingSegment SegmentId="ACT" />
    <Segment SegmentId="PER" Repeat="3" />
    <Segment SegmentId="UD" Repeat="1" />
    <Segment SegmentId="DTP" Repeat="19" />
    <Segment SegmentId="BLI" Repeat="1" />
    <Segment SegmentId="AMT" Repeat="9" />
    <Segment SegmentId="LIN" Repeat="1" />
    <Segment SegmentId="REF" Repeat="9" />
    <Segment SegmentId="K3" Repeat="3" />
    <Loop LoopId="LX" LoopRepeat="">
      <Name>Assigned Number</Name>
      <StartingSegment SegmentId="LX" />
      <Segment SegmentId="BLI" Repeat="1" />
      <Segment SegmentId="INV" Repeat="9" />
      <Segment SegmentId="UD" Repeat="1" />
      <Segment SegmentId="M1" Repeat="1" />
      <Segment SegmentId="DTP" Repeat="9" />
      <Segment SegmentId="RPA" Repeat="1" />
      <Segment SegmentId="K3" Repeat="3" />
      <Loop LoopId="BEN">
        <Name>Beneficiary or Owner Information</Name>
        <StartingSegment SegmentId="BEN" />
        <Segment SegmentId="NM1" Repeat="1" />
        <Segment SegmentId="N2" Repeat="1" />
        <Segment SegmentId="N3" Repeat="1" />
        <Segment SegmentId="N4" Repeat="1" />
        <Segment SegmentId="DTP" Repeat="1" />
      </Loop>
      <Loop LoopId="ENT">
        <Name>Entity</Name>
        <StartingSegment SegmentId="ENT" />
        <Segment SegmentId="NM1" Repeat="1" />
        <Segment SegmentId="N2" Repeat="2" />
        <Segment SegmentId="REF" Repeat="9" />
        <Segment SegmentId="N3" Repeat="3" />
        <Segment SegmentId="N4" Repeat="1" />
        <Segment SegmentId="PER" Repeat="3" />
        <Segment SegmentId="DMG" Repeat="1" />
        <Segment SegmentId="DMA" Repeat="1" />
        <Segment SegmentId="REL" Repeat="1" />
        <Segment SegmentId="UD" Repeat="1" />
        <Segment SegmentId="DTP" Repeat="9" />
        <Segment SegmentId="QTY" Repeat="9" />
        <Segment SegmentId="K3" Repeat="3" />
        <Loop LoopId="LQ" LoopRepeat="">
          <Name>Industry Code</Name>
          <StartingSegment SegmentId="LQ" />
          <Segment SegmentId="V9" Repeat="1" />
          <Segment SegmentId="DTP" Repeat="9" />
          <Segment SegmentId="K3" Repeat="3" />
          <Loop LoopId="NM1">
            <Name>Individual or Organizational Name</Name>
            <StartingSegment SegmentId="NM1" />
            <Segment SegmentId="N3" Repeat="3" />
            <Segment SegmentId="N4" Repeat="1" />
            <Segment SegmentId="G61" Repeat="9" />
          </Loop>
        </Loop>
        <Loop LoopId="BEN">
          <Name>Beneficiary or Owner Information</Name>
          <StartingSegment SegmentId="BEN" />
          <Segment SegmentId="NM1" Repeat="1" />
          <Segment SegmentId="N2" Repeat="1" />
          <Segment SegmentId="N3" Repeat="1" />
          <Segment SegmentId="N4" Repeat="1" />
          <Segment SegmentId="DTP" Repeat="1" />
        </Loop>
        <Loop LoopId="BLI">
          <Name>Baseline Item Data</Name>
          <StartingSegment SegmentId="BLI" />
          <Segment SegmentId="INV" Repeat="9" />
          <Segment SegmentId="UD" Repeat="1" />
          <Segment SegmentId="UDA" />
          <Segment SegmentId="M1" Repeat="1" />
          <Segment SegmentId="DTP" Repeat="9" />
          <Segment SegmentId="QTY" />
          <Segment SegmentId="RPA" />
          <Segment SegmentId="K3" Repeat="3" />
          <Loop LoopId="BEN">
            <Name>Beneficiary or Owner Information</Name>
            <StartingSegment SegmentId="BEN" />
            <Segment SegmentId="NM1" Repeat="1" />
            <Segment SegmentId="N2" Repeat="1" />
            <Segment SegmentId="N3" Repeat="1" />
            <Segment SegmentId="N4" Repeat="1" />
            <Segment SegmentId="DTP" Repeat="1" />
          </Loop>
        </Loop>
      </Loop>
    </Loop>
    <Loop LoopId="MSG">
      <Name>Message Text</Name>
      <StartingSegment SegmentId="MSG" />
      <Segment SegmentId="DTP" Repeat="1" />
      <Segment SegmentId="NM1" Repeat="1" />
    </Loop>
  </Loop>
</TransactionSpecification>